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Anterior rectocele and anorectal dysfunction

F Pucciani1, M L Rottoli, A Bologna

  • 1Clinica Chirurgica, Universita degli Studi di Firenze, Italy.

International Journal of Colorectal Disease
|January 1, 1996
PubMed
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Anterior rectocele types, distension (T1R) and displacement (T2R), show distinct anorectal function. T1R involves pelvic floor dyssynergia, while T2R exhibits pelvic floor descent, impacting bowel evacuation.

Area of Science:

  • Gastroenterology
  • Pelvic Floor Disorders
  • Anorectal Physiology

Background:

  • Anterior rectocele presents in two main types: distension (Type 1 Rectocele - T1R) and displacement (Type 2 Rectocele - T2R).
  • These rectocele types possess unique anatomical, clinical, and therapeutic characteristics.
  • Understanding anorectal function differences is crucial for effective management.

Purpose of the Study:

  • To investigate and compare anorectal functional parameters in patients diagnosed with Type 1 Rectocele (T1R) and Type 2 Rectocele (T2R).
  • To differentiate the functional profiles of distension versus displacement rectoceles.
  • To correlate manometric and defecographic findings with rectocele type.

Main Methods:

  • Study included three groups of symptomatic female patients (T1R, T2R, idiopathic constipation) and a control group of healthy females.

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  • All participants underwent clinical evaluation, colonic transit time (CTT) assessment, computerized anorectal manometry (CAM), and defecography.
  • Functional parameters analyzed included anal pressure, rectoanal inhibitory reflex (RAIR), anorectal angle, and pelvic floor descent during defecation.

    • Main Results:

    • Patients with T1R showed significantly higher anal pressure and impaired RAIR compared to other groups.
    • Patients with T2R exhibited the lowest anal pressure, normal RAIR, a significantly higher anorectal angle, and more abnormal pelvic floor descent.
    • Both rectocele groups reported symptomatic digital evacuation, though clinical evaluations were otherwise similar.

    Conclusions:

    • Distinct anorectal functional profiles characterize distension (T1R) and displacement (T2R) anterior rectoceles.
    • T1R is associated with pelvic floor dyssynergia, indicated by impaired manometric findings.
    • T2R is linked to pelvic floor descent, evidenced by defecographic abnormalities.